Disorders of self-awareness: Pathogenetic and clinical relevance in early schizophrenia

Abstract

Disorders of the self had already been considered in classic psychiatric literature and in phenomenological psychopathology as fundamental features of the spectrum of schizophrenic disorders. These experiential anomalies have been ignored by the contemporary psychiatry, because its behaviouristic orientation entails a mistrust of studying subjectivity. In this article, based on our own and other empirical studies, we present a phenomenologically-informed account of disorders of self-awareness that are detectable in the prodromal phases of schizophrenia as well as in the schizotypal conditions. We propose that a joint psychopathological and empirical emphasis on the disorders of self may facilitate an integration of the etiological search for neuro-developmental risk factors with the developmental-psychological approach to the ontogenesis of the self. Clinical familiarity with these subtle, yet crucial, symptomatic aspects of the vulnerability to schizophrenia may assist in the detection of pre-schizophrenic prodromal conditions in the non-psychotic clinical populations and thus enable early therapeutic interventions.